Instructions to Clerk: When this document is filed, the accompanying DR-150, Child Custody Jurisdiction Affidavit, must imm ediately be sealed. Its contents cannot be disclosed to other parties or the public unless the court orders di sclosure after a hearing. AS 25.30.380(e). Place a copy of this for m with the DR-150 Affidavit in a sealed envelope. Tie the original of this form in the case file. IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT ) ) ) ) ) ) ) ) ) ) CASE NO. DIRECTION TO SEAL AFFIDAVIT , say on oath or affir m under penalty of perjury that I, my or my children's health, safe ty, or liberty w ould be jeopardized by disclosure of identifying information contained in my Child Custody Jurisdiction Affidavit (DR-150). Therefore, as provided in AS 25.30.380(e), the court must seal the affidavit and may not disclose it to the other party or the public unless the court or ders the disclosure to be made after a hearing in which the court takes into consideration the health, safety, or liberty of me and my children and determines that the disclosure is in the interest of justice. Signature Subscribed and sworn to or affirmed before me at on . Date (SEAL) , Alaska Clerk of Court, Notary Public or other person authorized to administer oaths. My commission expires: Distribution: 1. original to court file 2. copy to sealed envelope 3. copy to opposing party 4. copy to requesting party AS 25.30.380 (e) American LegalNet, Inc. www.FormsWorkFlow.com I certify that on , a copy of this document (but not the child custody affidavit) was mailed to Signature of Party/Attorney DR-151 (3/12)(cs) DIRECTION TO SEAL AFFIDAVIT

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